The bladder drainage technique in pancreas transplantation--the Tübingen experience

Starting in 1987 renal- and pancreaticoduodenal--transplantations were performed simultaneously in a consecutive series of 40 patients with Type 1 diabetes mellitus and end-stage renal disease. Exocrine secretion of the pancreatic graft does not seem to be a crucial problem anymore when using the bladder drainage technique. No pancreatic fistulae were seen. No graft lost its function due to early post-operative graft thrombosis. Early post-operative graft pancreatitis and recurrent urinary tract infections remain the drawbacks of the bladder drainage technique. Despite a strong immunestimulation of the recipient by the combined pancreaticoduodenal/renal allograft all but two rejection episodes could be reversed by using different monoclonal/polyclonal antibodies. Actuarial 1-year-graft survival rate reaches 85% for the pancreas as well as the kidney. Thus, simultaneous pancreas-kidney transplantation can be performed with a high success rate when using the technique described.